CONTACT US

Please do not use this form in the case of emergencies. Call 911 in the case of a crisis or 211 for a referral for human services.

It may take 24-48 hours to receive a response to the inquiries submitted through the CCFSA website. We are happy to provide information about our programs or member agencies or respond to general inquiries through this site.

If you are not a Connecticut resident, please use the "Inquire by Email" button.

Zip Code *

Phone *

Phone

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How did you hear about this class? *

The fee for the class is $150. How will you be paying for the class? *

I will bring $150 in cash or money order to the class.

I will send a $150 check one week prior to my class.

I will bring a signed copy of my court fee waiver form to the class.

Is there anyone who you do NOT want to attend the same class as you? *

You have the right to attend the class together or separate from any individual.

I do not want a specific person attending the same class as me.

I have no preferences who attends the same class as me.

If you do not want a specific person attending the class with you, include his/her name.

Have there been any safety concerns or domestic violence issues between you and your child(ren)'s other parent? *

Yes, there have been safety concerns or domestic violence issues.

No, there have not been safety concerns or domestic violence issues.

If YES, please explain.

Are there currently any active restraining orders, protective orders or no contact orders for either parent? *

Yes, there are restraining/protective/no-contact orders.

No, there are not any restraining/protective/no-contact orders.

If YES, provide the type of order and the first AND last name of all individuals in the order.

Would you like to bring an adult guest with you to class? *

You are welcome to bring an adult guest (over 21 years of age) with you to the class, free of charge. Your guest may NOT be another adult who is ordered to take the class NOR can it be one of your own children.

If YES, please provide your guest's name.

Do you have any special needs to assist you in attending the class? *

If YES, please describe your needs and how we can best meet them.

By checking this box, you agree that you have read and understand the statement below. *

I understand that filling out this form does not guarantee me a spot in any specific Parent Education Class. If the organization is able to accommodate my request, I will receive an email confirming that I am registered for the desired class. If the requested class is not available, I will be provided with alternative classes by phone or email.